? Overview of prosthesis available for amputees
? Basics of evaluation of patients
? Prosthetic prescription
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Postoperative and Preprosthetic Care
Individuals with New Amputation
? Likely to experience acute surgical pain
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? Grieving the loss of his or her limb- requires significant psychologicaladjustment.
Early Goals
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? Healing of suture line and overall health
status.
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? Enhancing early single limb mobility and self-care
? Control of edema and pain management
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? Optimal shaping of the residual limb forprosthetic wear
? Assessment of the potential for prosthesis
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Assessing Residual Limb Length and Volume? Important determinants of readiness for prosthetic use, as well as
socket design
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? Stump length needs to be documented
? Limb volume and shape of a transtibial residual limb is assessed
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by taking successive circumferential measuresREHABILITATION
? Prosthesis
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? Conventional- Cheaper to produce but are heavy.
? Endolite - composite carbon fiber is used.
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? Has to be custom made and tailored to be useful to the patient.? A large number of patients do not use their prosthesis if it is
cumbersome or heavy
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Immediate postoperative prosthesis
The socket
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? Interface between the residual limb andthe prosthesis
? All the forces from the ground during gait
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are transferred to the limb
? Forces from the limb needed to control
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the motion of the prosthesis aretransferred to the prosthesis
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Extra component that is mounted directlyunder the socket to reduce amount of torque
and shock
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socket and pylon are concealed to within a
cosmetic cover.
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Potential of Use
Level K 0
? No potential to ambulate or transfer safely with assistance .
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Level K1? Potential to use a prosthesis for ambulation on level surfaces at fixed
cadence.
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? Limited and unlimited household ambulator.K1- Solid-ankle, cushion-heel (SACH) foot
? Most basic prosthetic foot available.
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? Immovable ankle and soft heel giveit the ability to absorb the impact of
heel strike
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? Provides minimal energy return.
? For limited functional ability and
potential to ambulate.
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Level K 2
? Potential for ambulation with the ability to traverse low-level
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environmental barriers such as curbs, stairs or uneven surfaces.
? Typical of the limited community ambulator
? lightweight, have a flexible keel, a multiaxial ankle, and provide some
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energy return
Level K 3
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? Potential for ambulation with variable cadence.? Ability to traverse most environmental barriers
? Have vocational, therapeutic, or exercise activity beyond simple
locomotion
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? Hydraulic ankle/Microprocessor
Level K 4
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? Potential for prosthetic ambulation
that exceeds basic ambulation skills,
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exhibiting high impact, stress, orenergy levels.
? Typical of the child, active adult, or
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athlete.
Selection of Foot- Importance?
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? Ground reaction forces are transmitted? Can be damaging to the person's residual limb, knee, hip, or back.
? Proper prosthesis - expand their capabilities and motivation
dramatically and allows them to improve range of activities
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? At least design for one level above
A J- 20 years old
? A soldier, was when he endured traumatic injuries after driving
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his motor vehicle over a landmine
? Below knee amputee
? Determined to run again and plans to enrol at a local college
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Which foot does he require?
? K1
? K2
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? K3? K4
Answer ? K3 for daily use and K4 for running
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Jaipur foot BK Prosthesis
? The shank is fabricated from locally
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manufactured, durable, high-quality, high-density polyethylene pipes (HDPE).
? The socket design used is either total
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contact, which is vacuum-formed using a
polypropylene sheet, or open-ended, using
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HDPE.? This custom-made shank / socket is fitted
with the Jaipur Foot.
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? Dorsi-flexion,
? Inversion / Eversion
? Transverse rotation
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? Enables amputees to walk,run, trek, swim, squat, sit cross
legged,
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? walk on uneven terrain, work in
wet muddy fields
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AMPUTATIONS OF THE HIP AND PELVIS?Through the femur from
5cm distal to the lesser
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trochanter .
?Disarticulations of the hip.
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?Hindquarter amputations.AMPUTATIONS OF THE UPPER LIMB
? Hand
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? Preserve as much function as is possible.? Salvage procedure
? Preserve length
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? Mobility and sensibility
? Functions of pinch and grasp are very important.
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AMPUTATIONS OF THE UPPER LIMB? Wrist Disarticulations- Separate the carpal bones from the radius
? Forearm amputations- substance of the radius and ulna
? Elbow disarticulations- Humerus is preserved
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? Arm amputations- 30% of humeral length? Disarticulation of shoulder- less than 30% of humerus
? forequarter amputation- Shoulder and scapula
AMPUTATIONS OF THE UPPER LIMB
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? Wrist amputations-preserve supination and pronation may betranscarpal or disarticulation through wrist.
? Transcarpal ? Flexion and extension of radiocarpal joints should be
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preserved
? Can be fitted with thin prosthetic wrist units.
? Long lever arm increases the ease and power to use the prosthesis.
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FOREARM AMPUTATIONS
? Preserve as much length as possible.
? A smal stump is preferable to a through elbow
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? Can be fitted with a good prosthesis.DISARTICULATION ELBOW
? Broad flair can be firmly grasped by the prosthesis
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socket? Humeral rotation can be transmitted to the
prosthesis.
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? Preferable to a more proximal amputation
ARM AMPUTATIONS
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? Trans condylar after prosthetic fitting function as elbowdisarticulations
? Proximal level amputations require and inside elbow lock
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mechanism and an elbow turntable
? Preserving the proximal humerus is valuable-cosmetical y the
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contour of the shoulder is preserved and the grip of the socket isbetter .
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SHOULDER AMPUTATIONS? Surgical neck
? Disarticulation of the shoulder
? Forequarter amputation
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? With prosthesis function is so severely impaired that the prosthesiscan only be used as a holding device when performing activities
with both hands.
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Conventional (body-powered)
transhumeral prosthesis
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Terminal Devices
PROSTHETIC PRESCRIPTION
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? socket design? skin-socket interface
? suspension strategy
? Additional modular components
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SUMMARY? Prosthetic rehabilitation of persons with amputations is both
challenging and rewarding.
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? Success is often difficult to measure purely in clinical terms
? Maximizing individual functional potential
? Appropriate amount of technology to assure acceptable outcomes
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are highly predictive of success.